NPIMap

Organization Active NPI

Southeast Orthopedic Specialists, Inc

  • Non-Pharmacy Dispensing Site
  • Saint Johns, FL
National Provider Identifier
1396469797
Registry record updated Sep 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
Legal business name
SOUTHEAST ORTHOPEDIC SPECIALISTS, INC
Practice address
3055 County Road 210 W Ste 110
St Johns, FL 32259-7001
Phone
(904) 634-0640
NPI assigned
Sep 28, 2022
Last updated
Sep 28, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brett PuckettNPI 1831150960
Title
President
Phone
(904) 634-0640

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X Primary

Addresses

Primary practice location

3055 County Road 210 W Ste 110
St Johns, FL 32259-7001

Mailing address

6800 Southpoint Pkwy Ste 200
Jacksonville, FL 32216-6221
Phone (904) 634-0640

National Provider Directory

National Provider Directory
Tax ID family
SE Orthopedic Specialists38 organizations share this tax ID, including this one

Other organizations with this tax ID 37

Organizations that report the same tax identification number in the National Provider Directory.

View all 37

Locations

6800 Southpoint Pkwy
Ste 200
Jacksonville, FL 32216
Phone (904) 725-6300

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1664323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664323200000",
    "number": "1396469797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6800 SOUTHPOINT PKWY STE 200",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322166221",
            "telephone_number": "904-634-0640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3055 COUNTY ROAD 210 W STE 110",
            "city": "ST JOHNS",
            "state": "FL",
            "postal_code": "322597001",
            "telephone_number": "904-634-0640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST ORTHOPEDIC SPECIALISTS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-28",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A",
        "authorized_official_last_name": "PUCKETT",
        "authorized_official_first_name": "BRETT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-634-0640"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Johns, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.